Abstract 13738: Diastolic to Systolic Velocity Ratio of Coronary Artery Flow at Basal Condition Indicates Coronary Microvessel Spasm in Normal Coronary Angiography
Background: Diastolic to systolic velocity ratio (DSVR) of coronary artery assessed by ultrasound Doppler technique at rest is clinically useful for detection of epicardial coronary artery stenosis. However, significance of DSVR in chest pain patients without obstructive coronary artery disease (CAD) is unknown. We investigated the significance of DSVR in abnormal coronary microcirculation with normal coronary angiography (CAG).
Methods: We enrolled consecutive 318 patients (63±11 years old; male 43%) suspected angina without obstructive CAD and performed intracoronary acetylcholine-provocation test (ACh test). Before (basal condition) and during the ACh test, average peak velocity and DSVR in left anterior descending coronary artery were measured with intracoronary Doppler FloWire and plasma levels of lactic acid (LA) were compared at aortic root and coronary sinus. We calculated coronary blood flow (CBF) and assessed adenosine triphosphate-mediated coronary flow reserve (CFR). We diagnosed coronary microvessel spasm (CMVS) by transient decline of CBF with chest pain and LA production without epicardial vasospasm by the ACh test. Patients without ischemic evidences by the ACh test and CFR were classified as the non-ischemic heart disease (non-IHD) group.
Results: CMVS was found in 40 patients (12.6%) predominantly in female (95%) and 68 patients (21.4%) were diagnosed as the non-IHD. In CMVS patients, the ACh test demonstrated significant decrease in CBF (−53.3±26.5%) and significant increase in cardiac LA production (+36.5±37.9%). DSVR at basal condition and CFR were significantly attenuated in the CMVS patients compared with the non-IHD group (DSVR; 1.6±0.2 vs. 1.9±0.5, p<0.01, CFR; 2.9±0.8 vs. 3.4±0.8, p=0.01). Multiple logistic regression analysis indicated that female (odds ratio [OR]: 4.9; p=0.049), age (OR: 0.95; p=0.037), body mass index (OR: 0.79; p<0.01), and the basal DSVR (OR: 0.08, p<0.01), but not CFR, were independently associated with the presence of CMVS.
Conclusions: Decreased basal values of DSVR significantly associated with CMVS in patients suspected angina with normal CAG. Measurement of DSVR at the basal condition could be useful to assess CMVS as dysfunctional coronary microcirculation without obstructive CAD.
- Ischemic heart disease
- Coronary artery disease
- Coronary microcirculation
- Doppler ultrasound
- © 2010 by American Heart Association, Inc.